Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants
Authors: Valerie Y. Chock, Haresh Kirpalani, Edward F. Bell, Sylvia Tan, Susan R. Hintz, M. Bethany Ball, Emily Smith, Abhik Das, Yvonne C. Loggins, Beena G. Sood, Lina F. Chalak, Myra H. Wyckoff, Stephen D. Kicklighter, Kathleen A. Kennedy, Ravi M. Patel, Waldemar A. Carlo, Karen J. Johnson, Kristi L. Watterberg, Pablo J. Sánchez, Abbot R. Laptook, Ruth B. Seabrook, C. Michael Cotten, Toni Mancini, Gregory M. Sokol, Robin K. Ohls, Anna Maria Hibbs, Brenda B. Poindexter, Anne Marie Reynolds, Sara B. DeMauro, Sanjay Chawla, Mariana Baserga, Michele C. Walsh, Rosemary D. Higgins, Krisa P. Van Meurs, Sharon L. Wright, Robin S. Roberts, Traci H. Mondoro, Catherine Levy, Leif D. Nelin, Nathalie L. Maitre, Sudarshan R. Jadcherla, Patricia Luzader, Christine A. Fortney, Julie Gutentag, Christopher J. Timan, Kristi Small, Rox Ann Sullivan, Lina Yoseff-Salameh, Jacqueline McCool, Melanie Stein, Erin Fearns, Aubrey Fowler, Jennifer Grothause, Stephanie Burkhardt, Jessica Purnell, Mary Ann Nelin, Helen Carey, Lindsay Pietruszewski, Margaret Sullivan, Julie Shadd, Jennifer Notestine, Cole Hague, Erna Clark, Michelle Chan, Courtney Park, Hallie Baugher, Demi R. Beckford, Bethany Miller, Laura Marzec, Kyrstin Warnimont, Carla M. Bann, Marie G. Gantz, Jeanette O'Donnell Auman, Annie Bayard, Donald J. Brambilla, Margaret M. Crawford, Jenna Gabrio, Jamie E. Newman, Carolyn M. Petrie Huitema, David Leblond, Dennis Wallace, Kristin M. Zaterka-Baxter, David K. Stevenson, Barbara Bentley, Maria Elena DeAnda, Anne M. DeBattista, Beth Earhart, Lynne C. Huffman, Casey E. Kruger, Ryan E. Lucash, Melinda S. Proud, Elizabeth N. Reichert, Dharshi Sivakumar, Heather Taylor, Hali E. Weiss, Namasivayam Ambalavanan, Monica V. Collins, Shirley S. Cosby, Myriam Peralta-Carcelen, Fred J. Biasini, Kristen C. Johnston, Mary Beth Moses, Tara E. McNair, Vivien A. Philips, Richard V. Rector, Sally Whitley, Kristy A. Domnanovich, Sheree York Chapman, Robin K. Whyte, Tarah T. Colaizy, John A. Widness, Jane E. Brumbaugh, Heidi M. Harmon, Jacky R. Walker, Claire A. Goeke, Mendi L. Schmelzel, Diane L. Eastman, Conra Backstrom Lacy, Janell Fuller, Mary Hanson, Carol Hartenberger, Elizabeth Kuan, Jean R. Lowe, Sandra Sundquist Beauman, Eric C. Eichenwald, Barbara Schmidt, Soraya Abbasi, Aasma S. Chaudhary, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Hallam Hurt, Jonathan Snyder, Kris Ziolkowski, Carl T. D'Angio, Ronnie Guillet, Melissa F. Carmen, Gary J. Myers, Kyle Binion, Melissa Bowman, Elizabeth Boylin, Caitlin Fallone, Osman Farooq, Julianne Hunn, Rosemary L. Jensen, Rachel Jones, Joan Merzbach, Constance Orne, Premini Sabaratnam, Ann Marie Scorsone, Holly I.M. Wadkins, Kelly Yost, Satyan Lakshminrusimha, Stephanie Guilford, Michelle E. Hartley-McAndrews, Ashley Williams, William Zorn, Emily Li, Jennifer Donato, Kimberly G. McKee, Kelly R. Coleman, Alison Kent, Luc P. Brion, Roy J. Heyne, Diana M. Vasil, Sally S. Adams, Maria M. De Leon, Francis Eubanks, Alicia Guzman, Elizabeth Heyne, Lizette E. Lee, Linda A. Madden, E. Rebecca McDougald, Lara Pavageau, Pollieanna Sepulveda, Cathy Twell Boatman, Kristine Tolentino-Plata, Azucena Vera, Jillian Waterbury, Bradley A. Yoder, Stephen. D. Minton, Mark J. Sheffield, Carrie A. Rau, Sarah Winter, Shawna Baker, Jill Burnett, Susan Christensen, Laura Cole Bledsoe, Sean Cunningham, Jennifer O. Elmont, Becky Hall, Trisha Marshant, Earl Maxson, Kandace M. McGrath, Hena G. Mickelsen, Galina Morshedzadeh, D. Melody Parry, Brixen A. Reich, Susan T. Schaefer, Ashley L. Stuart, Kelly Stout, Kimberlee Weaver-Lewis, Kathryn D. Woodbury, Seetha Shankaran, Rebecca Bara, Prashant Agarwal, Monika Bajaj, Kirsten Childs, Melissa February, Laura Goldston, Mary E. Johnson, Girija Natarajan, Bogdan Panaitescu, Eunice Woldt
Journal: JAMA Network Open (2023)

Importance Preterm infants with varying degrees of anemia have different tissue oxygen saturation responses to red blood cell (RBC) transfusion, and low cerebral saturation may be associated with adverse outcomes. Objective To determine whether RBC transfusion in preterm infants is associated with increases in cerebral and mesenteric tissue saturation (Csat and Msat, respectively) or decreases in cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE, respectively) and whether associations vary based on degree of anemia, and to investigate the association of Csat with death or neurodevelopmental impairment (NDI) at 22 to 26 months corrected age. Design, Setting, and Participants This was a prospective observational secondary study conducted among a subset of infants between August 2015 and April 2017 in the Transfusion of Prematures (TOP) multicenter randomized clinical trial at 16 neonatal intensive care units of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Preterm neonates with gestational age 22 to 28 weeks and birth weight 1000 g or less were randomized to higher or lower hemoglobin thresholds for transfusion. Data were analyzed between October 2020 and May 2022. Interventions Near-infrared spectroscopy monitoring of Csat and Msat. Main Outcomes and Measures Primary outcomes were changes in Csat, Msat, cFTOE, and mFTOE after transfusion between hemoglobin threshold groups, adjusting for age at transfusion, gestational age, birth weight stratum, and center. Secondary outcome at 22 to 26 months was death or NDI defined as cognitive delay (Bayley Scales of Infant and Toddler Development-III score &amp;amp;lt;85), cerebral palsy with Gross Motor Function Classification System level II or greater, or severe vision or hearing impairment. Results A total of 179 infants (45 [44.6%] male) with mean (SD) gestational age 25.9 (1.5) weeks were enrolled, and valid data were captured from 101 infants during 237 transfusion events. Transfusion was associated with a significant increase in mean Csat of 4.8% (95% CI, 2.7%-6.9%) in the lower–hemoglobin threshold group compared to 2.7% (95% CI, 1.2%-4.2%) in the higher–hemoglobin threshold group, while mean Msat increased 6.7% (95% CI, 2.4%-11.0%) vs 5.6% (95% CI, 2.7%-8.5%). Mean cFTOE and mFTOE decreased in both groups to a similar extent. There was no significant change in peripheral oxygen saturation (SpO 2 ) in either group (0.2% vs −0.2%). NDI or death occurred in 36 infants (37%). Number of transfusions with mean pretransfusion Csat less than 50% was associated with NDI or death (odds ratio, 2.41; 95% CI, 1.08-5.41; P = .03). Conclusions and Relevance In this secondary study of the TOP randomized clinical trial, Csat and Msat were increased after transfusion despite no change in SpO 2 . Lower pretransfusion Csat may be associated with adverse outcomes, supporting further investigation of targeted tissue saturation monitoring in preterm infants with anemia. Trial Registration ClinicalTrials.gov Identifier: NCT01702805